Canadian researchers investigating vitamin C as sepsis treatment

TORONTO — On New Year’s Day, a 24-year-old woman from Manitoba fell sick with the flu. Five days later, Joanne Ens died of sepsis — a condition that new analysis suggests is involved in one-in-five deaths worldwide.

“They had her in the back and they were trying to treat (her), but unfortunately she was in septic shock and she passed away that morning,” her husband, Dustin Ens, told CTV Winnipeg.

Sepsis is a life-threatening immune response that occurs when the body’s reaction to infection begins to damage its own tissue. Sepsis has been linked to a variety of health problems, including lung infections, urinary tract infections and is most common in bacterial infections.

In Canada, an estimated 30,000 deaths per year have been linked to sepsis.

New analysis published Thursday in The Lancet suggests sepsis is implicated in 20 per cent of deaths worldwide and is twice as prevalent as previously believed. In 2017, 11 million people worldwide died in connection with sepsis.

“It’s both quite common and deadly, and even when patients survive, they….are left with long-term effects,” Dr. François Lamontagne, a research professor at the Université de Sherbrooke, told CTV News.

But a team of Canadian doctors is trying to change those odds and improve survival by investigating the potential of Vitamin C infusions to protect the body from sepsis. The theory is that vitamin C could help protect organs and blood vessels that become vulnerable following the onset of sepsis.

“I feel excited and enthused by the prospect that this could be potentially life-saving therapy,” said Dr. Lamontagne. “If it is beneficial, it’s probably less expensive than a lot of the other treatments we administer.”

The new study includes some 800 sepsis patients and compares standard antibiotic treatment to the same treatment but with an added high dose of vitamin C infusions, administered by a drip.

The study is the largest of its kind ever conducted.

Smaller studies have shown that patients who received high doses of vitamin C spent fewer days in the intensive care unit. They also spent less time in hospital overall. The treatment is also considered relatively cheap, costing just about $60 per patient.

“It is unusual in that it is evaluating an existing treatment, intravenous vitamin C, whose importance for the treatment of scurvy was demonstrated in the 18th century. It turns out that vitamin C may also help the body’s response to infection by several mechanisms, not just one mechanism that is typically targeted by typical pharmaceuticals,” said Dr. Neill Adhikari, a co-investigator and intensive care specialist at Sunnybrook Health Sciences Centre in Toronto.

Among the study’s participants is 79-year-old Edward Bryant. He suddenly became ill last October, first with pneumonia and then with sepsis.

“I remember going in the ambulance. After that I don’t remember anything for about 4 days,” he said.

Not long after, Bryant ended up in a coma in Sherbook Hospital.

“The way he was lying there, I didn’t think he was going to make it,” recalled his wife, Patricia Bryant.

But Bryant recovered quickly and says he is now 100 per cent better. Doctors will know within a year if he was in the group of sepsis patients who received vitamin C infusions.

But other studies have shown that vitamin C used in combination with other ingredients made no difference. That makes this Canadian study all the more important, said Dr. Alison Fox-Robichaud, a professor in McMaster University’s department of medicine.

“Aside from antibiotics and intravenous fluids, we really have no treatment for sepsis … so I think this study is extremely important,” she said.

The Canadian study won’t be completed until 2022. But already, there has been enough interest that the research may expand to more countries in hopes of getting answers faster.

A GLOBAL PROBLEM

Dr. Tex Kissoon, a pediatric professor at the University of British Columbia, was a co-author in the new analysis published in The Lancet. He said the discovery that sepsis rates were twice what researchers previously believed represents a “seismic shift.”

“We were very surprised by this,” Kissoon told CTVNews.ca in a phone interview on Wednesday. “We did modelling over a period of years and we came to the conclusion that sepsis is indeed more common than we thought.”

Sepsis overwhelmingly affects children, with 40 per cent of cases occurring in kids younger than five. Eighty-five per cent of cases were reported in low- and middle-income countries in places such as sub-Saharan Africa, the South Pacific and Southeast Asia.

The findings are especially alarming because sepsis can often be prevented through basic public health care measures, such as vaccines, adequate nutrition and clean drinking water.

In the past, global estimates for sepsis were difficult to pinpoint because of a distinct lack of information from low-income countries where sepsis is most prevalent. The new analysis includes cases both in and out of hospital, as well as first-of-its-kind modelling to help measure the problem.

“Previous reports were only from hospitalized patients and in a few high-income countries, so it was a very incomplete picture of what sepsis was like in the world,” Dr. Kissoon said.

Combatting sepsis head-on could have overarching benefits, particularly in low-income countries where patients struggle to get treatment.

“We know that 40 per cent of patients with sepsis tend to have long-term disabilities,” Dr. Kissoon said. “It’s an economic loss for a country when you look at the years of life lost and years with disabilities.”

Researchers says sepsis is the number one killer of hospital patients in the U.S. In Canada, more needs to be done to understand the full scope of the problem, Dr. Kissoon said.

“What we rely on is forms that are filled out in hospitals … and in many cases the data we’re getting is incomplete,” he said. “So I think in Canada, we really need better data, a better way of capturing it.”

Dr. Kissoon’s research has taken him across the world to countries such as Uganda, Kenya and Bangladesh, where he got a first-hand look at the prevalence of sepsis. He is currently involved in a research project in Nunavut, where he said a lack of resources is a serious concern.

“Some of what we learned in Uganda, we’re doing work in Nunavut in children with the same sort of models. So it is an issue that we need to deal with in Canada,” he said.

According the analysis, global rates of sepsis appear to be dropping. Researchers found that there were an estimated 60.2 million sepsis cases in 1990, 15.7 million of which were fatal. By 2017, that number dropped by 19 per cent, to 48.9 million cases, with 11 million fatalities.

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